Thank you for all your ideas for how to move the investigation forward. We got the Snuffles dolls from the case-patients and sent them for testing. It turns out that all the kids who were cases had Snuffles dolls even if Snuffles wasn't their favorite doll. That happens sometimes based on how we ask for information in the questionnaires. The lab obtained specimens from the dolls and found a match for Coccidoides immitis genetic material and nothing else.

The company who manufactures the dolls has a plant located in Arizona, an endemic area. We contacted the doll’s manufacturer and, after presenting them the evidence from the investigation, they are ready to have a press conference. They asked if we could provide some information on cocci for them to use at the conference. We should provide the information in the form of a list of frequently asked questions (FAQ). We can just use a set of common questions for it, and provide the answers. The state and local health departments, who are the primary contact point for the public in situations like this and who are also parties we'll be working with, will use the FAQ afterwards for any calls they might receive.

Please write up answers to a commonly used list of frequently asked questions for the company so that they can schedule and conduct the press conference. This FAQ list should include any relevant data for the public to know so that they can be aware of warning signs of cocci, as well as how to keep themselves and their children safe in this outbreak. It is important to provide accurate information and data to prevent the public from going into a panic while still being empathetic to their concerns. It's also important to keep other groups in mind. Although we know who manufactured the doll, we do not know what caused the dolls be be contaminated and shouldn't try to point the finger at anyone. Our main goal is to get the people who may be at risk to take the necessary actions to ensure the safety of them and their children.

In addition, please draft any recall information or warnings that you think are necessary at this point.

I look forward to hearing from you!

Sam Lyons, MD